Inhaled Nitric Oxide Use in Pediatric Intensive Care

Acute lung injury (ALI) occurs in approximately 9% of mechanically ventilated children with 80% progressing to acute respiratory distress syndrome (ARDS). Inhaled nitric oxide (iNO) is an important therapy for neonates with persistent pulmonary hypertension, older children with pulmonary hypertension, and patients with congenital heart disease. It is hypothesized that iNO should benefit patients with ALI/ARDS by improving oxygenation. With this prospective observational trial, we found that clinician responsiveness to improved oxygenation was associated with less ventilator days. Algorithms to standardize ventilator management may improve signal to noise ratios in future trials enabling better assessment of the effect of inhaled nitric oxide on patient outcomes. Additionally, confining studies to more selective patient populations, such as those with right ventricular dysfunction, may be required.